Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2023; 15(4): 273-284
Published online Apr 16, 2023. doi: 10.4253/wjge.v15.i4.273
Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas
Katarzyna M Pawlak, Nadeem Tehami, Ben Maher, Shujaath Asif, Krishn Kant Rawal, Daniel Vasile Balaban, Mohammed Tag-Adeen, Fahd Ghalim, Wael A Abbas, Elsayed Ghoneem, Khaled Ragab, Mahmoud El-Ansary, Shanil Kadir, Sunil Amin, Keith Siau, Anna Wiechowska-Kozlowska, Klaus Mönkemüller, Dalia Abdelfatah, Abeer Abdellatef, Sundeep Lakhtakia, Hussein Hassan Okasha
Katarzyna M Pawlak, Endoscopy Unit, Department of Gastroenterology, Hospital of The Ministry of Interior and Administration, Szczecin 01-218, Poland
Nadeem Tehami, Ben Maher, Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
Shujaath Asif, Sundeep Lakhtakia, Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
Krishn Kant Rawal, Department of Gastroenterology, Prime Institute of Digestive Sciences, Rajkot 360001, India
Daniel Vasile Balaban, Department of Gastroenterology, Central Military Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 010011, Romania
Mohammed Tag-Adeen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena 83511, Egypt
Mohammed Tag-Adeen, Department of Endoscopy, Shefa Al-Orman Hospital, Luxor 85951, Egypt
Fahd Ghalim, Interventional Endoscopy Unit, Sainte Marie Hospital, OSNY 95520, France
Wael A Abbas, Department of Internal Medicine, Gastroenterology Unit, Faculty of Medicine, Assuit University, Assuit 71511, Egypt
Elsayed Ghoneem, Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
Khaled Ragab, Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
Mahmoud El-Ansary, Department of Hepatology & Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
Shanil Kadir, Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi 75900, Pakistan
Sunil Amin, Division of Digestive and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 32118, United States
Keith Siau, Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
Anna Wiechowska-Kozlowska, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin 71-146, Poland
Klaus Mönkemüller, Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, AL 35294, United States
Dalia Abdelfatah, Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11511, Egypt
Abeer Abdellatef, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11511, Egypt
Hussein Hassan Okasha, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
Author contributions: Pawlak KM, Tehami N, Maher B, Asif S, Rawal KK, El-Ansary M, Kadir S, Abdelfatah D, Awad A, and Lakhtakia S have been involved equally in writing the manuscript; Balaban DV, Tag-Adeen M, Ghalim F, Abbas W, Ghoneem E, and Ragab K have been involved equally in collecting the data; Amin S, Siau K, Wiechowska-Kozłowska A, and Mönkemüller K have been involved equally in reading and revising the manuscript; Okasha HH revised and approved the final manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was conducted and carried out in accordance with the Helsinki declaration as revised in 1989. Based on the anonymized data collection, the Institutional Review Board of Pomeranian Medical University in Szczecin granted approval. SVU, MED018.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hussein Hassan Okasha, MD, Professor, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini Hospitals, Cairo University, PO: 11451, Kasr Al-Aini Street, Cairo 11451, Egypt. hussein_okasha@kasralainy.edu.eg
Received: December 22, 2022
Peer-review started: December 22, 2022
First decision: February 8, 2023
Revised: February 17, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 16, 2023
Processing time: 112 Days and 11.2 Hours
ARTICLE HIGHLIGHTS
Research background

Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.

Research motivation

There is a paucity of data regarding the imaging assessment of these lesions.

Research objectives

To determine the characteristic EUS features of SPN and define its role in preoperative assessment.

Research methods

This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics.

Research results

One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation (MPD) was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: FNA (67/106; 63.2%), FNB (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed.

Research conclusions

SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPNs did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used did appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.

Research perspectives

We propose that a prospective international study of SPN would further improve our understanding of this rare tumor.